# A 12-year-old child with aplastic anemia is admitted to the pediatric unit. Which nursing intervention is the highest priority to prevent life-threatening complications? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542180 > language: ko > subject: Child Health ## 문제 A 12-year-old child with aplastic anemia is admitted to the pediatric unit. Which nursing intervention is the highest priority to prevent life-threatening complications? What is the most critical safety measure for a pediatric patient with aplastic anemia? ## 보기 1. Encourage increased fluid intake to prevent dehydration 2. Provide a high-protein diet to promote tissue repair 3. Implement strict protective isolation precautions **✔ 정답** 4. Monitor for signs of developmental delays **정답: 3** ## 해설 Aplastic anemia causes severe pancytopenia with critically low white blood cell counts, making infection prevention the absolute priority through protective isolation. Aplastic anemia is a serious hematologic disorder caused by bone marrow failure, characterized by pancytopenia where all blood cell types—red blood cells, white blood cells, and platelets—are severely reduced. In pediatric patients, this condition poses an immediate life-threatening risk, requiring aggressive safety interventions. The most critical concern for children with aplastic anemia is the severely compromised immune system due to neutropenia (low neutrophil counts). When white blood cell counts often drop below 500/mm³, these patients have almost no ability to fight infections. Even minor exposure to bacteria, viruses, or fungi can rapidly progress to sepsis and lead to death. Therefore, implementing strict protective isolation precautions becomes the highest-priority nursing intervention. Protective isolation involves placing the child in a private room with positive pressure, requiring all visitors and healthcare staff to wear masks, gowns, and gloves, restricting fresh flowers or plants, ensuring all food is thoroughly cooked, and maintaining meticulous hand hygiene. These measures create a barrier between the immunocompromised child and potential sources of infection. Nursing assessment must continuously monitor for subtle signs of infection such as slight temperature elevation, behavioral changes, or unusual fatigue, as the typical inflammatory response may be absent due to the lack of white blood cells. This vigilant monitoring combined with protective isolation forms the foundation of safe nursing care for pediatric aplastic anemia patients. ## 심화 해설 Clinical Judgment This question evaluates Prioritization and Clinical Judgment in a patient with Aplastic Anemia. The core is identifying which of the three major complications of Pancytopenia (infection, bleeding, anemia) is the most acutely life-threatening. Aplastic anemia causes the bone marrow to fail to produce sufficient blood cells, leading to simultaneous Neutropenia, Thrombocytopenia, and Anemia. Among these, infection due to neutropenia can progress most rapidly to Sepsis and death, making it the highest priority for monitoring. Option 3, "elevated temperature with chills," is a critical clue for infection requiring immediate medical intervention. Memory Tip: Use **A** **B** **C** to remember the priority. The complications of aplastic anemia are **A**nemia, **B**leeding, and **C**hemotaxis issues (infection). Among these, **C** (infection) is the most **C**ritical. KR vs US: While fever in an aplastic anemia patient is also considered an emergency in Korea, the US NGN/NCLEX heavily emphasizes the concept that "Fever in a neutropenic patient is an ONCOLOGIC EMERGENCY." Protocols are strictly established, defining fever in a neutropenic patient as a life-threatening situation where antibiotic administration must begin within 1 hour. ## 임상 시나리오 Clinical Safety Protocol for the Neutropenic Child For a 12-year-old admitted with aplastic anemia and severe neutropenia (ANC < 500/µL), the immediate nursing priority is establishing a protective environment. The goal is to minimize the child's exposure to bacterial and fungal pathogens, which can rapidly lead to fatal sepsis due to the absence of an immune response. Immediate Isolation Precautions - Place the patient in a private, positive-pressure room with HEPA filtration if available. - Strict hand hygiene with antimicrobial soap or alcohol-based rub before and after all patient contact. - No fresh flowers, plants, or standing water in the room to eliminate fungal reservoirs. - Restrict visitors; anyone with signs of infection must not enter. All visitors must perform hand hygiene and wear a mask. Daily Surveillance and Care - Monitor vital signs every 4 hours, with immediate reporting of any temperature spike (single oral temp > 38.3°C or sustained > 38.0°C for 1 hour). - Inspect skin and mucous membranes daily for any breaks, redness, or lesions, as these are portals for infection. - Avoid rectal temperatures, suppositories, and invasive procedures when possible to prevent mucosal trauma. - Administer prophylactic antimicrobials as prescribed; do not delay if a fever develops—prompt initiation of broad-spectrum antibiotics is critical. Patient and Family Education Teach the family that the child has no ability to fight infection. Emphasize that strict adherence to isolation is temporary but non-negotiable. Instruct on proper handwashing technique and the rationale for dietary restrictions, such as avoiding raw fruits, vegetables, and undercooked meats to reduce pathogen ingestion. ## 핵심 개념 - **Aplastic Anemia** — Aplastic anemia. A condition in which the bone marrow does not produce enough blood cells (red blood cells, white blood cells, platelets). - **Pancytopenia** — Pancytopenia. A condition where all three major blood cell types (red blood cells, white blood cells, platelets) are reduced below normal levels. - **Neutropenia** — Neutropenia. A condition where the number of neutrophils, the main white blood cells that fight infection, is abnormally low. It greatly increases the risk of infection, which is a major cause of death in aplastic anemia. - **Protective Isolation (Reverse Isolation)** — Protective isolation (reverse isolation). Measures to protect immunocompromised patients from external environmental pathogens. Includes private room, strict hand hygiene, and use of protective equipment (gown, gloves, mask). - **Sepsis** — Sepsis. A condition where a systemic inflammatory response to infection causes life-threatening organ dysfunction. 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